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2013AppTR Download

2012-13 TRANSFEr Application For Spring 2013 or Fall 2013 Enrollment. Enter your legal name, Birth Date and current mailing address for all admission correspondence. If the online system did not ask you to answer some of these questions, this college chose not to ask that question.

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JCortes93

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0% found this document useful (0 votes)

79 views5 pages

2013AppTR Download

Uploaded by

JCortes93

We take content rights seriously. If you suspect this is your content, claim it here.

Available Formats

Download as PDF, TXT or read online on Scribd

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2012-13 TRANSFEr Application

For Spring 2013 or Fall 2013 Enrollment

APPLIC ANT
Legal Name ___________________________________________________________________________________________________________________
Last/Family/Sur (Enter name exactly as it appears on official documents.)

First/Given

Middle (complete)

Jr., etc.

Preferred name, if not rst name (only one) ____________________________

Former last name(s) _____________________________________________

Birth Date ____________________________________________________

Female Male

US Social Security Number, if any ___________________________________

mm/dd/yyyy

Required for US Citizens and Permanent Residents applying for financial aid via FAFSA

Preferred Telephone Home Cell Home (_______) __________________________________ Cell (_______) __________________________________
Area/Country/City Code

Area/Country/City Code

E-mail Address ________________________________________________

IM Address ____________________________________________________

Permanent home address __________________________________________________________________________________________________________

Number & Street

Apartment #

____________________________________________________________________________________________________________________________
City/Town

County or Parish

State/Province

If different from above, please give your current mailing address for all admission correspondence.

Country

ZIP/Postal Code

(from _ to _)

(mm/dd/yyyy)

Current mailing address __________________________________________________________________________________________________________

Number & Street

Apartment #

____________________________________________________________________________________________________________________________
City/Town

County or Parish

State/Province

Country

ZIP/Postal Code

If your current mailing address is a college or university, include name of school here: ____________________________________________________________
_____

FUTURE PLANS
Your answers to these questions will vary for different colleges. If the online system did not ask you to answer some of the questions you see in this section, this college
chose not to ask that question of its applicants.
College ________________________________________________________

Deadline ______________________________________________________
mm/dd/yyyy

Entry Term: Fall (Jul-Dec)

Spring (Jan-Jun)

Do you intend to apply for need-based nancial aid?

Academic Interests _____________________________________________

____________________________________________________________

Do you intend to apply for merit-based scholarships?

Do you intend to be a full-time student?
Do you intend to enroll in a degree program your rst year?

Yes
Yes
Yes
Yes

No
No
No
No

____________________________________________________________

Do you intend to live in college housing? ______________________________

Career Interest_________________________________________________

What is the highest degree you intend to earn? _________________________

DEMOGRAPHICS
Citizenship Status ______________________________________________

1. Are you Hispanic/Latino?

Non-US Citizenship ______________________________________________

Yes, Hispanic or Latino (including Spain) No

If yes, please describe your background.

_____________________________________________________________

____________________________________________________________

_____________________________________________________________

2. Regardless of your answer to the prior question, please indicate how you identify
yourself. (Check one or more and describe your background.)

Birthplace ________________________________________________________

American Indian or Alaska Native (including all Original Peoples of the Americas)

City/Town

State/Province

Country

Years lived in the US? ____________ Years lived outside the US? ____________
Language Prociency (Check all that apply.)
S(Speak) R(Read) W(Write) F(First Language) H(Spoken at Home)

____________________________________________________________

_______________________________________________
_______________________________________________
_______________________________________________
Optional The items with a gray background are optional. No information you
provide will be used in a discriminatory manner.
Religious Preference _______________________________________________

US Armed Services veteran status _____________________________________

2012 The Common Application, Inc.

Are you Enrolled? Yes No If yes, please enter Tribal Enrollment Number________________

Asian (including Indian subcontinent and Philippines)

____________________________________________________________

Black or African American (including Africa and Caribbean)

____________________________________________________________

Native Hawaiian or Other Pacic Islander (Original Peoples)

____________________________________________________________

White (including Middle Eastern)

___________________________________________________________
AP-1 / 2012-13

FAMILY
Please list both parents below, even if one or more is deceased or no longer has legal responsibilities toward you. Many colleges collect this information for demographic
purposes even if you are an adult or an emancipated minor. If you are a minor with a legal guardian (an individual or government entity), then please list that information
below as well. If you wish, you may list step-parents and/or other adults with whom you reside, or who otherwise care for you, in the Additional Information section.

Household
Parents marital status (relative to each other): Never Married Married Civil Union/Domestic Partners Widowed Separated Divorced (date _________)
With whom do you make your permanent home?

Parent 1

Parent 2

Both

Legal Guardian

Ward of the Court/State

mm/yyyy

Other

If you have children, how many? _________

Parent 1
Mother

Parent 2
Mother

Father Unknown
Is Parent 1 living? Yes No (Date Deceased ____________________)

Father Unknown
Is Parent 2 living? Yes No (Date Deceased ____________________)

____________________________________________________________

mm/yyyy

Last/Family/Sur

First/Given

mm/yyyy

Middle

Last/Family/Sur

First/Given

Middle

Former last name(s) _____________________________________________

Country of birth ________________________________________________

Home address if different from yours

____________________________________________________________

Preferred Telephone: Home Cell Work (_) __________

Area/Country/City Code

E-mail _______________________________________________________

Occupation _____________________________________________________

Employer _____________________________________________________

College (if any) ___________________________ CEEB

Degree _________________________________ Year _

Graduate School (if any) ____________________ CEEB

Degree _________________________________ Year _

Legal Guardian

Siblings

(if other than a parent)

Country of birth ________________________________________________

Please give names and ages of your brothers or sisters. If they are enrolled in
grades K-12 (or international equivalent), list their grade levels. If they have
attended or are currently attending college, give the names of the undergraduate
institution, degree earned, and approximate dates of attendance. If more than
three siblings, please list them in the Additional Information section.

Home address if different from yours

____________________________________________________________

Name

Relationship to you _______________________________________________

____________________________________________________________
Last/Family/Sur

First/Given

Middle

Title (Mr./Mrs./Ms./Dr.)

____________________________________________________________
Preferred Telephone: Home Cell Work (_______) ________________
Area/Country/City Code

E-mail _______________________________________________________

Age & Grade

Relationship

College Attended _____________________________ CEEB _

Degree earned _________________________ Dates __________________
mm/yyyy mm/yyyy
or expected
____________________________________________________________
Name

Age & Grade

Relationship

Occupation _____________________________________________________

College Attended _____________________________ CEEB _

Employer _____________________________________________________

Degree earned _______ Dates

mm/yyyy mm/yyyy
or expected

College (if any) ___________________________ CEEB

____________________________________________________________
Degree _________________________________________ Year _________
Graduate School (if any) ____________________________ CEEB ________
Degree _________________________________________ Year _________

2012 The Common Application, Inc.

Name

Age & Grade

Relationship

College Attended _____________________________ CEEB _

Degree earned _________________________ Dates __________________
mm/yyyy mm/yyyy
or expected

AP-2 / 2012-13

EDUC ATION
Colleges & Universities Are you currently enrolled in college? Yes No
Current or most recent college or university attended_____________________________________________________________________________________
Entry Date __________________

Exit Date __________________

mm/yyyy

School Type Public Independent

This is a 2-year 4-year institution

mm/yyyy

Address ______________________________________________________ CEEB/ACT code _

Number & Street

__________________________________________________________________________________________________________________________________
City/Town

State/Province

Country

ZIP/Postal Code

Advisors name (Mr./Mrs./Ms./Dr.) ____ Advisors title

E-mail __________________________________ Telephone (_______) ______________________ Fax (_______) _________________________________
Area/Country/City Code

Number

Ext.

Area/Country/City Code

Number

Report all college attendance beginning with your rst year of college and mark all that apply: taught on college campus (CO); taught on high school campus, excluding
AP/IB (HS); taught online (ON); college credit awarded (CR); transcript available (TR); degree candidate (DC). Please have ofcial transcripts sent as soon as possible.
College/University Name & CEEB/ACT Code

Location (City, State/Province, ZIP/Postal Code, Country)

CO HS ON

CR TR DC

Dates Attended

Degree Earned

mm/yyyy mm/yyyy

_________________________________ ___________________________________________
_________________________________ ___________________________________________

______________ _________
______________ _________

_________________________________ ___________________________________________
______________ _________
Do you expect to earn a degree prior to enrolling at the college to which you are applying? Yes No If so, what type of degree? _________________________
Are you a member of Phi Theta Kappa? Yes No

Secondary Schools
List all secondary schools you have attended and have the school you graduated from/attended most recently send a Final Report, ofcial transcript, and school prole.
Name of School & CEEB/ACT Code

Location (City, State/Province, ZIP/Postal Code, Country)

_____________________________________________
_____________________________________________
_____________________________________________
Secondary School Graduate Date __________________

Dates Attended (mm/yyyy)

mm/dd/yyyy

Please list any community program/organization that has provided free assistance with your application process:______________________________________________
If your education was interrupted, please indicate so here and provide details in the Additional Information section:___________________________________________

AC ADEMICS
The self-reported information in this section is not intended to take the place of your ofcial records. Please note the requirements of each institution to which you are
applying and arrange for ofcial transcripts and score reports to be sent from your secondary school and the appropriate testing agencies. Where Best Scores are
requested, please report the highest individual scores you have earned so far, even if those scores are from different test dates.
Secondary
School
Class Rank _________ Class Size _________ Weighted? Yes No
GPA _________ Scale _________ Weighted? Yes No
(if available)
(if available)
Grades
ACT
Exam Dates: ________ ________ ________
Best Scores: _________ ______
_________ ______
_________ ______
(past & future)

mm/yyyy

(so far)

COMP

mm/yyyy

_________ ______
Reading

SAT

Exam Dates: __________

(past & future)

__________

mm/dd/yyyy

mm/yyyy

Best Scores: __

mm/dd/yyyy

(so far)

Critical Reading

mm/dd/yyyy

English

mm/yyyy

_________ ______
Science

mm/yyyy

______ __________
Math

mm/dd/yyyy

Math

mm/yyyy

_________ ______
Writing

mm/yyyy

______ __________
Writing

mm/dd/yyyy

TOEFL/
Exam Dates: ________ ________ ________
Best Score: _________ ______ ______
(past & future)
mm/yyyy
mm/yyyy
mm/yyyy
(so far)
Test
Score
mm/yyyy
IELTS
________ __________________________________ _____
AP/IB/SAT Best Scores: ________ __________________________________ _____
Type & Subject
Score
mm/yyyy
Type & Subject
Score
Subjects (per subject, so far) mm/yyyy
________ __________________________________ _____
________ __________________________________ _____
mm/yyyy

Type & Subject

Score

______________________ _

mm/yyyy

Type & Subject

Score

______________________ _

mm/yyyy

Type & Subject

Score

mm/yyyy

Type & Subject

Score

______________________ _

mm/yyyy

Type & Subject

Score

______________________ _

mm/yyyy

Type & Subject

Score

Current Courses Please indicate title, level (100-level, 200-level, etc.) and credit value of all courses you are taking this year. Indicate quarter classes taken in the
same semester on the appropriate semester line. If you are not currently enrolled in college, please list the courses you took most recently.
Full Year/First Semester/First Trimester

Second Semester/Second Trimester

Third Trimester
or additional rst/second term courses if more space is needed

________________________________________
________________________________________
________________________________________
________________________________________
________________________________________
________________________________________
________________________________________
________________________________________

2012 The Common Application, Inc.

_________________________________________
_________________________________________
_________________________________________
_________________________________________
_________________________________________
_________________________________________
_________________________________________
_________________________________________
AP-3 / 2012-13

Honors Briey list any academic distinctions or honors you have received since the 9 th grade or international equivalent (e.g., National Merit, Cum Laude Society).
S(School) S/R(State or Regional N(National) I(International)

Grade level

Honor

11 12 FY SO JR

Highest Level of
Recognition
S S/R N I

_________________________________________________________________________________________________

EXTRACURRICULAR ACTIVITIES & WORK EXPERIENCE

Extracurricular Please list your principal extracurricular, volunteer, and work activities in their order of importance to you. Feel free to group your activities and
paid work experience separately if you prefer. Use the space available to provide details of your activities and accomplishments (specic events, varsity letter, musical
instrument, employer, etc.). To allow us to focus on the highlights of your activities, please complete this section even if you plan to attach a rsum.
Grade level
11 12 FY SO JR

Approximate
time spent
Hours
per week

When did you participate

in the activity?
Summer/
Weeks School School
per year
year
Break